TY - JOUR
T1 - Pain, Depression, and Posttraumatic Stress Disorder following Major Extremity Trauma among United States Military Serving in Iraq and Afghanistan
T2 - Results from the Military Extremity Trauma and Amputation/Limb Salvage Study
AU - Castillo, Renan C.
AU - Carlini, Anthony R.
AU - Doukas, William C.
AU - Hayda, Roman A.
AU - Frisch, Harold M.
AU - Andersen, Romney C.
AU - D’Alleyrand, Jean Claude
AU - Mazurek, Michael T.
AU - Ficke, James R.
AU - Keeling, John J.
AU - Pasquina, Paul F.
AU - Wain, Harold J.
AU - MacKenzie, Ellen J.
N1 - Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Objectives: Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes. Design: A retrospective cohort study. Setting: Four U.S. military treatment facilities: Walter Reed Army Medical Center, National Naval Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego. Patients/Participants: Four hundred twenty-nine United States service members who sustained a major limb injury while serving in Afghanistan or Iraq met eligibility criteria upon review of their medical records. Intervention: Not applicable. Main Outcome Measurements: Outcomes assessed were: function using the short musculoskeletal functional assessment; PTSD using the PTSD Checklist and diagnostic and statistical manual criteria; pain using the chronic pain grade scale. Results: Military extremity trauma and amputation/limb salvage patients without pain, depression, or PTSD, were, on average, about one minimally clinically important difference (MCID) from age- and gender-adjusted population norms. In contrast, patients with low levels of pain and no depression or PTSD were, on average, one to 2 MCIDs from population norms. Military extremity trauma and amputation/limb salvage patients with either greater levels of pain, and who experience PTSD, depression, or both, were 4 to 6 MCIDs from population norms. Regression analyses adjusting for injury type (upper or lower limb, salvage or amputation, and unilateral or bilateral), age, time to interview, military rank, presence of a major upper limb injury, social support, presence of mild traumatic brain injury/concussion, and combat experiences showed that higher levels of pain, depression, and PTSD were associated with lower one-year functional outcomes. Conclusions: Major limb trauma sustained in the military results in significant long-term pain and PTSD. Overall, the results are consistent with the hypothesis that pain, depression, and PTSD are associated with disability in this population.
AB - Objectives: Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes. Design: A retrospective cohort study. Setting: Four U.S. military treatment facilities: Walter Reed Army Medical Center, National Naval Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego. Patients/Participants: Four hundred twenty-nine United States service members who sustained a major limb injury while serving in Afghanistan or Iraq met eligibility criteria upon review of their medical records. Intervention: Not applicable. Main Outcome Measurements: Outcomes assessed were: function using the short musculoskeletal functional assessment; PTSD using the PTSD Checklist and diagnostic and statistical manual criteria; pain using the chronic pain grade scale. Results: Military extremity trauma and amputation/limb salvage patients without pain, depression, or PTSD, were, on average, about one minimally clinically important difference (MCID) from age- and gender-adjusted population norms. In contrast, patients with low levels of pain and no depression or PTSD were, on average, one to 2 MCIDs from population norms. Military extremity trauma and amputation/limb salvage patients with either greater levels of pain, and who experience PTSD, depression, or both, were 4 to 6 MCIDs from population norms. Regression analyses adjusting for injury type (upper or lower limb, salvage or amputation, and unilateral or bilateral), age, time to interview, military rank, presence of a major upper limb injury, social support, presence of mild traumatic brain injury/concussion, and combat experiences showed that higher levels of pain, depression, and PTSD were associated with lower one-year functional outcomes. Conclusions: Major limb trauma sustained in the military results in significant long-term pain and PTSD. Overall, the results are consistent with the hypothesis that pain, depression, and PTSD are associated with disability in this population.
KW - PTSD
KW - chronic pain
KW - orthopaedic trauma
KW - veteran
UR - http://www.scopus.com/inward/record.url?scp=85102153001&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85102153001&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000001921
DO - 10.1097/BOT.0000000000001921
M3 - Review article
C2 - 33079837
AN - SCOPUS:85102153001
SN - 0890-5339
VL - 35
SP - E96-E102
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 3
ER -